Provider Demographics
NPI:1245637446
Name:KUCKLICK, PAMELA SUE (LPCC-S-SUPV)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:KUCKLICK
Suffix:
Gender:F
Credentials:LPCC-S-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2802
Mailing Address - Country:US
Mailing Address - Phone:216-906-0940
Mailing Address - Fax:
Practice Address - Street 1:4115 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3304
Practice Address - Country:US
Practice Address - Phone:216-651-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0006764-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health